No office rate
31200 describes partial ethmoidectomy through an extranasal approach. This code describes an intranasal anterior ethmoid procedure.
On this page
CMS RVU26D · Effective 2026-10-01
31205 Ethmoidectomy Medicare reimbursement rates in Rhode Island
Reports surgical removal of anterior ethmoid cells through an intranasal approach for disease requiring ethmoid surgery, rather than an extranasal or endoscopic procedure. Compare 31205 office and facility rates across CMS payment localities in Rhode Island.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 31205 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$859.63
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Sinus surgery
About 31205: Intranasal anterior ethmoidectomy
Reports surgical removal of anterior ethmoid cells through an intranasal approach for disease requiring ethmoid surgery, rather than an extranasal or endoscopic procedure.
This procedure removes diseased anterior ethmoid air cells through the nasal cavity using a nonendoscopic intranasal approach. Otolaryngologists typically perform it in an operating room for ethmoid sinus disease requiring surgical treatment. The operative report should make clear that the approach was intranasal and identify the anterior ethmoid work performed; endoscopic ethmoidectomy and extranasal ethmoidectomy are distinct approaches with separate codes.
Report the code when the documented operation matches this approach and extent, not based on the diagnosis alone. It has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, CMS pays at 150%. Assistant-at-surgery payment may be available; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 31205
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.32 · 41%
- Practice expense (office) RVU13.94 · 55%
- Malpractice RVU0.92 · 4%
236
Medicare services in 2024 · #4181 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
31205 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
31201 describes total ethmoidectomy through an extranasal approach. Choose this code when the documented work is intranasal and anterior.
$446.18
31254 is an endoscopic partial ethmoidectomy. This code applies to an intranasal procedure performed without the endoscopic approach.
No office rate
31255 is an endoscopic total ethmoidectomy. This code applies to the intranasal anterior ethmoid procedure, not endoscopic total removal.
Compare 31205 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
Unavailable
Facility
$859.63
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 31205 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
3,520
- Code
- 31205
- Physician work
- 10.32
- Practice expense
- 13.94
- Malpractice
- 0.92
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.32 | × 1.019 | 10.5161 |
| Practice expense | 13.94 | × 1.033 | 14.4000 |
| Malpractice | 0.92 | × 0.892 | 0.8206 |
| Total RVUs | 25.7367 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$859.63
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.32 | 1.019 |
| Practice expense | 13.94 | 1.033 |
| Malpractice | 0.92 | 0.892 |
(10.32 × 1.019 + 13.94 × 1.033 + 0.92 × 0.892) × $33.4009 = $859.63
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
31205 billing questions
How does this differ from endoscopic ethmoidectomy?
This code is for an intranasal, nonendoscopic anterior ethmoid procedure. Endoscopic ethmoidectomy codes apply when the surgeon performs the work using a nasal endoscope.
How do I distinguish it from codes 31200 and 31201?
Those codes describe extranasal ethmoidectomy. Use this code for the intranasal anterior approach documented in the operative report.
What documentation supports reporting this code?
The operative report should identify the intranasal approach and the anterior ethmoid removal performed. A diagnosis of ethmoid sinus disease alone does not establish the procedure.
How is bilateral surgery reported?
Report modifier 50 for bilateral performance. CMS pays the bilateral procedure at 150%.
What global and multiple-procedure rules apply?
The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,5173119F,,No eval activity clin symp,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,51831200,,Removal of ethmoid sinus,A,,5.01,12.05,NA,12.05,,0.43,17.49,17.49,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,51931201,,Removal of ethmoid sinus,A,,8.39,11.62,NA,11.62,,1.23,21.24,21.24,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,52031205,,Removal of ethmoid sinus,A,,10.32,13.94,NA,13.94,,0.92,25.18,25.18,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,5213120F,,12-lead ecg performed,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,52231225,,Removal of upper jaw,A,,26.03,17.40,NA,17.40,,3.80,47.23,47.23,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,52331230,,Removal of upper jaw,A,,30.05,17.80,NA,17.80,,4.38,52.23,52.23,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537